Burke, Julia Mauve NEW YORK STATE DEPARTMENT OF HEALTH _ I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Julia Mauve Burke Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/15/2022 _ 0 years War or Dates
✓ Place of Death Hospital, Institution or
W City, T90aStr)(A Glens Falls Street Address Glens Falls H.acpita►
Manner of Death 1. Natural Cause ❑Accident ❑Homicide ['Suicide ❑Undetermined El Pending
Lk7 Circumstances Investigation
W Medical Certifier Name Title
LZ Danielle Goert7en Mn
Address
90 South Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Twaxr Xitax Glens Falls 5601 2
'' ❑Burial Date Cemetery or Crematory
❑Entombment 08/17/2022 Pine View Cematory
Address
:.EICremation Queensbury, Ry
Date Place Removed
❑Removal and/or Held
and/or Address
i" Hold
CA
0 Date Point of
t
Transportation Shipment
C by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
s Address
68 Main Street Hudson Falls, N Y 12801
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
a
ILI
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/17/2022 Registrar of Vital Statistics
(si ature)
District Number 5601 Place Glens Falls
>. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
77
LEI Date of Disposition S li81 ZZ Place of Disposition - -r,,� C
--_
2 (address)
.40
(section) (Iyit number) (grave number)
cy Name of Sexton or Person in arge of Pre ises n., - ,Av`
(please int)
Uat
Signature Title VVVVVV 6 �p)
`
(over)
DOH-1555 (02/2004)
i r i � ^r C
rublic Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial.permit
Official Funeral Directors Reg.or License#